company that is the prime contract holder with the Virginia Department of Health. Along with other subcontractors and state healthcare stakeholders, the organizations are in the process of designing, testing and fully implementing an HIE that facilitates healthcare information exchange between au- thorized healthcare providers throughout the state.

direct messaging capabilities that allow healthcare providers to share clinical data securely, exchanging lab results, treat- ment summaries, discharge forms, care plans and other docu- ments. Since standards-based interoperability and security are linchpins of a successful HIE and its ability to participate effectively with the NwHIN, the ConnectVirginia HIE has been designed to meet standards that will ensure effective functioning on a standalone basis and as part of a larger con- nected healthcare ecosystem.

The principles on which these design standards are based were defined by the Direct Project, a consortium of health- care technology experts and other stakeholders in the initia- tive that works together to identify attributes that promote secure healthcare information exchange capabilities across the U.S. The Direct Project was established by the Office of the National Coordinator of Health Information Technology (ONC) in 2010. As a Direct Project participant, MEDfx has played a key role in designing systems that encrypt healthcare information so that authorized providers can access and share vital patient data to more efficiently and effectively plan and deliver care.

Pushing and pulling information ConnectVirginia envisions a two-way data transmission system that enables participating healthcare providers to exchange medical records quickly and efficiently. It includes a direct messaging system to allow healthcare professionals to &ldquo;push&rdquo; information on patients to other authorized providers, and an exchange system that allows them to &ldquo;pull&rdquo; data for a more complete view of their patients&rsquo; medical histories. The ConnectVirginia DIRECT messaging service functions similarly to email, but with the additional layers of security needed to safeguard confidential information and fully meet the privacy guidelines identified by regulatory agencies and the Direct Project. Only registered medical care providers have access to the direct messaging system, which they can use in place of the faxes that are widely used to exchange clinical information now. The direct messaging system allows authorized clinicians to exchange information, such as patient referrals and care transition plans. The next stage of ConnectVirginia&rsquo;s HIE implementation, which is ongoing, will enable authorized providers to pull patient data through an exchange function that provides a highly secure query and records-retrieval system. The Con- nectVirginia EXCHANGE service is designed around the

NwHIN standards that were articulated by the ONC, and healthcare providers and organizations who meet the legal and technology requirements will be able to join the program and gain access to their patients&rsquo; medical histories from other participating providers to enable coordinated care.

Creating a truly connected healthcare ecosystem The ConnectVirginia rollout is in process, as are HIE ef- forts in all 50 states. Ultimately, the goal is to build a strong network in each state and connect regional HIEs with the NwHIN. By building secure, interoperable systems from the ground up, state HIEs are paving the way for medical profes- sionals and patients alike to reap the benefits of a connected healthcare ecosystem, which includes better outcomes and lower costs.

Although still in the launch phase, the ConnectVirginia project has demonstrated that public and private organiza- tions can work together to effect transformational change in the way healthcare is delivered, not only in Virginia but on a national scale. The program&rsquo;s direct messaging function al- lows physicians to securely provide data to other authorized providers, replacing outmoded systems, such as fax machines, with electronic data-sharing capabilities to promote greater levels of collaboration. Planned data-exchange capabilities will allow physicians to gain access to their patients&rsquo; entire medical histories, enabling medical professionals to move beyond their data-provider roles to become data consumers, take a more holistic view of their patients&rsquo; medical needs and formulate care plans accordingly, with input from the entire care team. Successful HIEs &ndash; those that are designed with robust security capabilities, meet stringent data management and interoperability standards and connect seamlessly with the NwHIN &ndash; are forming the backbone of a larger connected healthcare ecosystem. The new communication capabilities that are emerging from this effort have the potential to fun- damentally transform healthcare delivery, achieving the goals of improving outcomes and reducing costs.